Fight the Treatment Industrial Complex

AFSC-Arizona staff are amazing advocates for prisoners - and as such, are true blessings to our communities. Spend time on their site - lots of resources.

RUSTBELT RADIO

NATIVE RESISTANCE AND THE CARCERAL STATE

Retiring Arizona Prison Watch...

This site was originally started in July 2009 as an independent endeavor to monitor conditions in Arizona's criminal justice system, as well as offer some critical analysis of the prison industrial complex from a prison abolitionist/anarchist's perspective. It was begun in the aftermath of the death of Marcia Powell, a 48 year old AZ state prisoner who was left in an outdoor cage in the desert sun for over four hours while on a 10-minute suicide watch. That was at ASPC-Perryville, in Goodyear, AZ, in May 2009.

Marcia, a seriously mentally ill woman with a meth habit sentenced to the minimum mandatory 27 months in prison for prostitution was already deemed by society as disposable. She was therefore easily ignored by numerous prison officers as she pleaded for water and relief from the sun for four hours. She was ultimately found collapsed in her own feces, with second degree burns on her body, her organs failing, and her body exceeding the 108 degrees the thermometer would record. 16 officers and staff were disciplined for her death, but no one was ever prosecuted for her homicide. Her story is here.

Marcia's death and this blog compelled me to work for the next 5 1/2 years to document and challenge the prison industrial complex in AZ, most specifically as manifested in the Arizona Department of Corrections. I corresponded with over 1,000 prisoners in that time, as well as many of their loved ones, offering all what resources I could find for fighting the AZ DOC themselves - most regarding their health or matters of personal safety.

I also began to work with the survivors of prison violence, as I often heard from the loved ones of the dead, and learned their stories. During that time I memorialized the Ghosts of Jan Brewer - state prisoners under her regime who were lost to neglect, suicide or violence - across the city's sidewalks in large chalk murals. Some of that art is here.

In November 2014 I left Phoenix abruptly to care for my family. By early 2015 I was no longer keeping up this blog site, save occasional posts about a young prisoner in solitary confinement in Arpaio's jail, Jessie B.

I'm deeply grateful to the prisoners who educated, confided in, and encouraged me throughout the years I did this work. My life has been made all the more rich and meaningful by their engagement.

I've linked to some posts about advocating for state prisoner health and safety to the right, as well as other resources for families and friends. If you are in need of additional assistance fighting the prison industrial complex in Arizona - or if you care to offer some aid to the cause - please contact the Phoenix Anarchist Black Cross at PO Box 7241 / Tempe, AZ 85281. collective@phoenixabc.org

Saturday, June 21, 2014

Excellent but troubling article below from Prison Legal News: print and send it to prisoners! Prisoner subscriptions to Prison Legal News are only $30 a year for the print edition (for prisoners), and one of the best investments you can make.

Corizon,
the nation’s largest for-profit medical services provider for prisons,
jails and other detention facilities, was formed in June 2011 through
the merger of Prison Health Services (PHS) and Correctional Medical
Services (CMS).

In April 2013, the debt-rating agency Moody’s
downgraded Corizon’s nearly $360 million worth of debt to a rating of
B2 – an indication the company’s debt is highly speculative and a high
credit risk. According to Moody’s, the rating downgrade was due to an
“expectation of earnings volatility following recent contract losses,
margin declines from competitive pricing pressure on new and renewed
contracts, and Moody’s belief that Valitás [Corizon’s parent
corporation] will be unable to restore metrics to levels commensurate
with the prior B1 rating over the near to intermediate term.”

On
September 23, 2013, Moody’s again downgraded Corizon’s debt rating and
changed the company’s rating outlook from “stable” to “negative.” The
following month Corizon announced that it had replaced CEO Rich
Hallworth with Woodrow A. Myers, Jr., the former chief medical officer
at WellPoint Health. Hallworth, who had been appointed Corizon’s CEO in
2011, previously served as the president and CEO of PHS. At the same
time that Hallworth was replaced, Corizon president Stuart Campbell also
stepped down.

Prison Medical Care for Profit

According
to Corizon’s website, the company provides healthcare services at over
530 correctional facilities serving approximately 378,000 prisoners in
28 states. In addition, Corizon employs around 14,000 staff members and
contractors. The company’s corporate headquarters is located in
Brentwood, Tennessee and its operational headquarters is in St. Louis,
Missouri.

The 2011 merger that created Corizon involved
Valitás Health Services, the parent company of CMS, and America Service
Group, the parent company of PHS. The Nashville Business Journal
reported the deal was valued at $250 million.

“Corizon’s
vision is firmly centered around service – to our clients, our patients
and our employees,” Campbell said at the time. “To that we add the
insight of unparalleled experience assisting our client partners, and
caring professionals serving the unique healthcare needs of
[incarcerated] patients.”

Corizon has around $1.5 billion in
annual revenue and contracts to provide medical services for the prison
systems in 13 states. The company also contracts with numerous cities
and counties to provide healthcare to prisoners held in local jails;
some of Corizon’s larger municipal clients include Atlanta, Philadelphia
and New York City (including the Rikers Island jail). Additionally, the
company has its own in-house pharmacy division, PharmaCorr, Inc.

The
prison healthcare market has flourished as state Departments of
Corrections and local governments seek ways to save money and reduce
exposure to litigation. [See: PLN, May 2012, p.22]. Only a few major
companies dominate the industry. Corizon’s competitors include Wexford
Health Sources, Armor Correctional Health Services, NaphCare, Correct
Care Solutions and Centurion Managed Care – the latter being a joint
venture of MHM Services and Centene Corporation. Around 20 states
outsource all or some of the medical services in their prison systems.

As
Corizon is privately held, there is little transparency with respect to
its internal operations and financial information, including costs of
litigation when prisoners (or their surviving family members) sue the
company, often alleging inadequate medical care.

For example,
when Corizon was questioned by the news media in Florida during a
contract renewal, the company initially tried to prevent the release of
its litigation history, claiming it was a “trade secret.”

In
2012, Corizon agreed to settle a lawsuit filed against PHS – one of its
predecessor companies – by Prison Legal News, seeking records related to
the resolution of legal claims against the firm in Vermont. Based on
the records produced pursuant to that settlement, PHS paid out almost
$1.8 million in just six cases involving Vermont prisoners from 2007 to
2011. [See: PLN, Dec. 2012, p.16].

Companies like Corizon
provide healthcare in prisons and jails under the HMO model, with an
emphasis on cutting costs – except that prisoners have no other options
to obtain medical treatment except through the contractor.

Arizona DOC

A
former Corizon nurse had her license suspended and is currently under
investigation by the Arizona State Board of Nursing for incompetence. In
January 2014, nurse Patricia Talboy was accused of contaminating vials
of insulin at three units at the ASPC-Lewis prison, potentially exposing
two dozen prisoners to HIV or hepatitis.

Talboy reportedly
used a needle to stick prisoners’ fingers to check their blood sugar
levels. She then used the same needle to draw insulin from vials of the
medication utilized for multiple prisoners, possibly contaminating the
insulin in the vials. After placing the vials back into inventory, other
staff members may have unknowingly used them to dispense insulin.

“Every
indication is that the incident is the result of the failure by one
individual nurse to follow specific, standard and well-established
nursing protocols when dispensing injected insulin to 24 inmates,”
Arizona Department of Corrections (ADC) director Charles L. Ryan said in
a January 9, 2014 statement.

Talboy’s failure to follow
procedures was discovered after a prisoner told a different nurse about
the issue. Corizon reportedly delayed three days before publicly
reporting the incident; in a press release, the company admitted that
one of its nurses had been involved in “improper procedures for
injections.” Talboy received her nursing license in August 2012 and
became an RN in June 2013; as a rookie nurse, Corizon likely paid her
less than more experienced nurses.

Following the
insulin-related incident, the company was ordered to develop a
comprehensive plan that includes “supplemental training and competency
testing procedures for blood glucose testing and administration of
insulin,” as well as “nurse-peer reporting education to ensure
professional accountability” and “patient awareness education on
injection protocols.”

Corizon has a three-year, approximately
$370 million contract to provide medical care in Arizona state prisons,
which began in March 2013. The contract award generated controversy
because former ADC director Terry Stewart was hired by Corizon as a
consultant; current director Charles Ryan had previously worked under
Stewart, raising a potential conflict of interest. Ryan denied any
improprieties.

According to a report by the American Friends
Service Committee released in October 2013, titled “Death Yards:
Continuing Problems with Arizona’s Correctional Health Care,” medical
services in Arizona prisons did not improve after Corizon replaced
Wexford as the ADC’s healthcare contractor. “Correspondence from
prisoners; analysis of medical records, autopsy reports, and
investigations; and interviews with anonymous prison staff and outside
experts indicate that, if anything, things have gotten worse,” the
report stated.

Florida DOC

In 2013, the Florida
Department of Corrections (FDOC) awarded Corizon a five-year, $1.2
billion contract to provide medical services to state prisoners in north
and central Florida. Wexford Health Sources was contracted to provide
similar services in the southern region of the state for $240 million.
[See: PLN, June 2013, p.24]. The wholesale privatization of healthcare
in Florida’s prison system followed a 2011 legislative decision to
disband the state’s Correctional Medical Authority, which had oversight
over prison medical care. [See: PLN, May 2012, p.30].

The
contracts were part of the Republican administration’s initiative to
expand privatization of government services, including prison management
and healthcare, in spite of previous setbacks. In 2006, PHS withdrew
two months into an almost $800 million contract to provide medical care
to Florida prisoners; at that time, the company said the contract was
not cost-effective and claimed it would lose money.

The 2013
contract awards to Corizon and Wexford followed a two-year legal fight.
In 2011, AFSCME Florida and the Federation of Physicians and
Dentists/Alliance of Healthcare and Professional Employees filed suit
challenging the prison healthcare contracts, in an effort to protect the
jobs of nearly 2,600 state workers.

On June 21, 2013 the
First District Court of Appeals approved the privatization of medical
care in FDOC facilities, overturning a ruling by the Leon County Circuit
Court. The appellate court noted in its decision that “The LBC
[Legislative Budget Committee] simply moved funds from different line
items within the Department’s Health Services’ program, providing
additional funds for contracts that the Department otherwise had the
authority to enter.” See: Crews v. Florida Public Employers Council 79,
113 So.3d 1063 (Fla. Dist. Ct. App. 1st Dist. 2013).

Under
the terms of the FDOC’s contract with Corizon, the company must provide
medical care to Florida state prisoners for 7% less than it cost the
FDOC in 2010. When entering into the contract, state officials
apparently had few concerns about the numerous lawsuits previously filed
against Corizon, and no hard feelings toward the company’s predecessor,
PHS, when it terminated its 2006 contract to provide medical services
to Florida prisoners because it wasn’t profitable.

“Most
people feel, as long as they achieve their 7 percent savings who cares
how they treat inmates?” noted Michael Hallett, a professor of
criminology at the University of North Florida.

Florida Counties

In
a September 6, 2012 unpublished ruling, the Eleventh Circuit Court of
Appeals affirmed a $1.2 million Florida jury verdict that found Corizon –
when it was operating as PHS – had a policy or custom of refusing to
send prisoners to hospitals. The Court of Appeals held it was reasonable
for jurors to conclude that PHS had delayed medical treatment in order
to save money. See: Fields v. Corizon Health, 490 Fed.Appx. 174 (11th
Cir. 2012).

The jury verdict resulted from a suit filed
against Corizon by former prisoner Brett A. Fields, Jr. In July 2007,
Fields was being held in the Lee County, Florida jail on two misdemeanor
convictions. After notifying PHS staff for several weeks that an
infection was not improving, even with antibiotics that had been
prescribed, Fields was diagnosed with MRSA. PHS did not send him to a
hospital despite escalating symptoms, including uncontrolled twitching,
partial paralysis and his intestines protruding from his rectum. A
subsequent MRI scan revealed that Fields had a severe spinal
compression; he was left partly paralyzed due to inadequate medical
care.

The Eleventh Circuit wrote that PHS “enforced its
restrictive policy against sending prisoners to the hospital,” and noted
that a PHS nurse who treated Fields at the jail “testified that, at
monthly nurses’ meetings, medical supervisors ‘yelled a lot about nurses
sending inmates to hospitals.’” Further, PHS “instructed nurses to be
sure that the inmate had an emergency because it cost money to send
inmates to the hospital.”

At trial, the jury found that PHS
had a custom or policy of deliberate indifference that violated Fields’
constitutional right to be free from cruel and unusual punishment. The
jurors concluded that Fields had a serious medical need, PHS was
deliberately indifferent to that serious medical need, and the company’s
actions proximately caused Fields’ injuries. The jury awarded him
$700,000 in compensatory damages and $500,000 in punitive damages. [See:
PLN, March 2013, p.54; Aug. 2011, p.24].

More recently, the
estate of a 21-year-old prisoner who died at a jail in Manatee County,
Florida filed a lawsuit in October 2013 against the Manatee County
Sheriff’s Office and Corizon, the jail’s healthcare provider. The
complaint accuses the defendants of deliberate indifference to the
serious medical needs of Jovon Frazier and violating his rights under
the Eighth Amendment.

In February 2009, Frazier was
incarcerated at the Manatee County Jail; at the time of his medical
intake screening, staff employed by Corizon, then operating as PHS,
noted that his health was unremarkable. Frazier submitted a medical
request form in July 2009, complaining of severe pain in his left
shoulder and arm, and a PHS nurse gave him Tylenol.

Throughout
August and September 2009, Frazier submitted five more medical requests
seeking treatment for his arm and shoulder. “It really hurts! HELP!” he
wrote in one of the requests. PHS employees saw him and recorded his
vital signs. Despite the repeated complaints, Frazier was never referred
to a doctor or physician assistant; on September 9, 2009 his treatment
was documented as routine but he was placed on the “MD’s list.”

An
X-ray was taken on September 17, 2009 to rule out a shoulder fracture.
The X-ray was negative for a fracture, and Frazier was not referred to a
doctor. He submitted two more medical requests that month and five
requests in October 2009 seeking treatment for his increasingly painful
condition. The complaint alleges that in total, Frazier submitted 13
medical request forms related to pain over a period of three months; he
was seen by a nurse each time but not examined by a physician.

On
October 29, 2009, Frazier received an X-ray to determine if he had a
tendon injury. An MRI was recommended and he was transported to a
hospital where an MRI scan revealed a large soft tissue mass on his
shoulder. A doctor at the hospital, concerned that the mass was
cancerous, recommended additional tests.

After being
diagnosed with osteosarcoma, a form of bone cancer, Frazier was returned
to the jail and subsequently treated at the Moffitt Cancer Center,
where he received chemotherapy, medication and surgery. Despite this
aggressive treatment the cancer progressed and Frazier’s left arm was
amputated. The cancer continued to spread, however, and he was diagnosed
with lung cancer in June 2011. He died within three months of that
diagnosis, on September 18, 2011.

In a letter to the attorney
representing Frazier’s estate, Florida oncologist Howard R. Abel wrote
that the lack of treatment provided by Corizon at the Manatee County
Jail constituted “gross negligence and a reckless disregard to Mr.
Frazier’s right to timely and professionally appropriate medical care.”

The
lawsuit filed by Frazier’s estate claims that Corizon was aware of his
serious medical condition but failed to provide adequate treatment. In
addition, the complaint contends the company has a widespread custom,
policy and practice of discouraging medical staff from referring
prisoners to outside medical practitioners and from providing expensive
medical tests and procedures. Finally, the lawsuit states that “Corizon
implemented these widespread customs, policies and practices for
financial reasons and in deliberate indifference to [the] serious
medical needs of Frazier and other inmates incarcerated at Manatee
County Jail.”

On January 10, 2014, U.S. District Court Judge
James Moody denied Corizon’s motion to dismiss the case. The company had
argued that the allegations in the lawsuit failed to assert sufficient
facts to establish deliberate indifference, amounted only to medical
negligence and were insufficient to establish gross negligence, and
failed “to adequately allege a policy or custom that violated Frazier’s
rights.” Judge Moody disagreed, finding the claims set forth in the
complaint were “sufficient to establish a constitutional violation.”

The
Manatee County Sheriff’s Office had better luck with its motion to
dismiss. The Sheriff argued the complaint did not establish facts
indicating that the jail had a similar practice – like Corizon – of
providing deliberately indifferent medical care to prisoners. The court
agreed and dismissed the claims against the Sheriff’s Office; the claims
against Corizon remain pending. See: Jenkins v. Manatee County Sheriff,
U.S.D.C. (M.D. Fla.), Case No. 8:13-cv-02796-JSM-TGW.

Idaho DOC

In
February 2013, the Idaho Department of Corrections (IDOC) announced it
had reached a one-year extended agreement with Corizon to provide
medical care in the state’s prison system. However, the Idaho Business
Review reported that the extension also resulted in a rate increase.
Then-Corizon president Stuart Campbell informed the IDOC Board of
Correction that the company wouldn’t sign an extension for less money,
stating the current contract had become too costly. During the preceding
three years of the contract the IDOC had incurred approximately 20% in
cumulative rate increases.

Both sides agreed that the
contract would run through December 2013 and the IDOC would pay an
additional $250,000. It seems odd that Idaho was willing to continue
contracting with the company, though, as the relationship between the
IDOC and Corizon has been a rocky one.

The quality of medical
care at the Idaho State Correctional Institution (ISCI) in Boise has
been an ongoing issue for nearly three decades. The prison was the focus
of a class-action lawsuit filed on behalf of prisoners alleging a
variety of problems, including inadequate healthcare. The lawsuit was
known as the Balla litigation after plaintiff Walter Balla.

In
July 2011, after new complaints were filed regarding medical care at
ISCI, U.S District Court Judge B. Lynn Winmill appointed a special
master, Dr. Marc F. Stern, to assess the situation at the facility. The
court wanted Stern to confirm whether ISCI was in compliance with the
temporary agreements established in the Balla case, and to investigate
and report on “the constitutionality of healthcare” at the facility.

Dr.
Stern, a former health services director for the Washington Department
of Corrections who also had previously worked for CMS, one of Corizon’s
predecessor companies, issued a scathing report in February 2012. With
the aid of psychiatrist Dr. Amanda Ruiz, Stern and his team reviewed
ISCI over a six-day period and met with dozens of prisoners,
administrators and Corizon employees.

Stern stated in the
report’s executive summary: “I found serious problems with the delivery
of medical and mental health care. Many of these problems have either
resulted or risk resulting in serious harm to prisoners at ISCI. In
multiple ways, these conditions violate the rights of prisoners at ISCI
to be protected from cruel and unusual punishment. Since many of these
problems are frequent, pervasive, long-standing, and authorities are or
should have been aware of them, it is my opinion that authorities are
deliberately indifferent to the serious health care needs of their
charges.”

The report found that prisoners who were terminally
ill or in long-term care were sometimes left in soiled linens, given
inadequate pain medication and went for long periods without food or
water. The findings regarding sick call noted instances in which
prisoners’ requests either resulted in no care, delayed care or
treatment that was deemed dangerous. Emergency care situations had
insufficient oversight, delays or no response; inadequately trained
medical staff operated independently during emergencies without
oversight from an RN or physician. The report also found problems with
the pharmacy and medication distribution at ISCI.

In one
case, a prisoner with a “history of heart disease was inexplicably
dropped from the rolls of the heart disease Chronic Care Clinic.” As a
result, medical staff stopped conducting regular check-ups and
assessments related to the prisoner’s heart condition. A few years later
the prisoner went in for a routine visit, complaining of occasional
chest pain. No evaluation or treatment was ordered and the prisoner died
four days later due to a heart attack. In another case, Corizon staff
failed to notify a prisoner for seven months that an X-ray indicated he
might have cancer.

Dr. Stern’s report not only reviewed
processes but also staff competency and adequacy. The report cited
allegations that a dialysis nurse at ISCI overtly did not like
prisoners, and routinely “failed to provide food and water to patients
during dialysis, prematurely aborted dialysis sessions or simply did not
provide them [dialysis] at all and failed to provide ordered
medications resulting in patients becoming anemic.” Stern concluded that
prison officials were aware of this issue and the danger it presented
to prisoners, but “unduly delayed taking action.”

The mental
health care provided by Corizon at ISCI was found to be deficient by Dr.
Ruiz, who conducted the psychiatric portion of the court-ordered
review. The report noted that the facility had 1) inadequate “screening
of and evaluating prisoners to identify those in need of mental health
care,” 2) “significant deficiencies in the treatment program at ISCI”
which was “violative of patients’ constitutional right to health care,”
3) an “insufficient number of psychiatric practitioners at ISCI,” 4)
incomplete or inaccurate treatment records, 5) problems with
psychotropic medications, which were prescribed with no face-to-face
visits or follow-up visits with prisoners and 6) inadequate suicide
prevention training.

The report concluded: “The state of
guiding documents, the inmate grievance system, death reviews and a
mental health CQI [continuous quality improvement] system at ISCI is
poor. While not in and of themselves unconstitutional, it is important
for the court to be aware of this and its possible contribution to other
unconstitutional events.”

In March 2012, shortly after Dr.
Stern’s report was released over the objection of state officials,
Corizon disagreed with its findings. The company retained the National
Commission on Correctional Health Care (NCCHC) to review the report.
Corizon described the review as an “independent assessment,” even though
it was paying NCCHC accreditation fees.

The NCCHC review
consisted of a three-person team assessing the facility over a two-day
period in April 2012. Unlike Stern’s assessment of medical and mental
health care, the NCCHC team did not interview prisoners or include a
psychiatrist. Regardless, the agency concluded that “The basic structure
of health services delivery at ISCI meets NCCHC’s standards.”

Corizon
stated in a press release that Dr. Stern’s report was “incomplete,
misleading and erroneous,” and then-CEO Rich Hallworth appeared in a
video defending the company. The NCCHC had previously accredited
Corizon’s healthcare services at ISCI, thus in essence the NCCHC’s
review was self-validating the organization’s prior accreditation
findings. Also, according to NCCHC’s website, two Corizon officials sit
on the agency’s health professionals certification board of trustees.

Corizon’s
criticism of Dr. Stern’s report is just one example where the company
has objected to an independent, third-party assessment of its medical
services. The Balla case settled in May 2012 after 30 years of
litigation. [See: PLN, Feb. 2013, p.40].

Indiana DOC

Following
a competitive bidding process, Corizon was selected to continue
providing medical care to Indiana state prisoners under a three-year
contract effective January 1, 2014. The contract has a cap of $293
million, based on a per diem fee of $9.41 per prisoner.

Three
weeks later, a lawsuit filed in federal court named Corizon and the
Indiana Department of Correction as defendants in connection with the
wrongful death of prisoner Rachel Wood. Wood, 26, a first-time drug
offender, died in April 2012; the suit, filed on behalf of her family,
claims she was transferred from prison to prison and denied care for her
serious medical conditions, which included lupus and a blood clotting
disorder.

“Notwithstanding the duty of the prison medical
staff to provide adequate medical care to Rachel and to treat her very
serious life threatening conditions, prison medical staff willfully and
callously disregarded her condition, and allowed Rachel to deteriorate
and die,” the complaint stated.

“That is just the attitude of
these guys, is saving money rather than providing health care,” said
Michael K. Sutherlin, the attorney representing Wood’s family.

Prison
officials reportedly moved Wood among several different prisons and
hospitals, and at one point lost track of her and claimed she had
escaped even though she was still incarcerated.

In
an October 2013 Bangor Daily News article, Steve Lewicki, coordinator
of the Maine Prisoner Advocacy Coalition, discussed the state of
healthcare in Maine’s prison system. “Complaints by prisoners are less,”
he said, noting that while medical services provided to prisoners are
better than in the past, there are still concerns. This relative
improvement coincided with the end of the state’s contract with Corizon.
The contract, valued at approximately $19.5 million, was awarded to
another company in 2012.

A year earlier, the Maine
legislature’s Office of Program Evaluation and Government Accountability
(OPEGA) completed a review of medical services in state prisons. The
agency contracted with an independent consultant, MGT of America, to
conduct most of the fieldwork, and the review included services provided
under Corizon’s predecessor company, CMS.

The OPEGA report,
issued in November 2011, cited various deficiencies in medical care at
Maine prisons – including medications not always being properly
administered and recorded by CMS staff. Although the company was
notified of the problem, no corrective action was taken. CMS employees
did not follow policies related to medical intake and medical records;
OPEGA reported that 38% of prisoners’ medical files had inadequate or
inaccurate documentation regarding annual physical assessments, and that
files were not complete or consistently maintained. The report found
11% of sick calls reviewed were either not resolved timely or had no
documented resolution. OPEGA also criticized CMS for inadequate staff
training.

At a January 2012 legislative committee hearing,
state Senator Roger Katz asked Corizon regional vice president Larry
Amberger, “My question to you is in light of this history, why should
the state seriously be considering any proposal your company might make
to get this contract back again?”

In response, Amberger
criticized the methodology used by MGT during the assessment and said he
believed Corizon provided quality medical care. Questioning and
challenging the findings of an independent reviewer is the same tactic
the company used in Idaho. Regardless, Corizon’s contract to provide
medical care to Maine state prisoners is now a part of history.

Louisville, Kentucky

While
some jurisdictions, like Maine, have chosen not to renew their
contracts with Corizon due to performance-related problems, in 2013 the
Metro Department of Corrections in Louisville, Kentucky (LMC) offered
the company a chance to rebid for its $5.5 million contract to provide
medical care at the LMC jail. This time, however, it was Corizon that
said “no thanks.”

The rebid offer was made even though seven
healthcare-related prisoner deaths occurred in a seven-month period in
2012 during Corizon’s prior contract, which expired in February 2013.
Nevertheless, LMC and Corizon agreed to extend the contract through July
30, 2013 on a month-to-month basis pending a formal rebid.

After
the expiration of the month-to-month contract extension, Corizon
notified LMC that it was no longer interested in providing services to
the corrections department and would not seek to rebid the contract. LMC
director Mark Bolton told the Courier Journal he was “surprised” by the
company’s decision. What seems more surprising is that LMC wanted to
continue contracting with Corizon to provide medical services in spite
of the number of prisoner deaths.

In April 2012, Savannah
Sparks, 27, a heroin addict and mother of three, was arrested and held
on shoplifting charges at the LMC jail. While withdrawing from heroin
she vomited, sweat profusely, could not sit up, could not eat or drink,
and defecated and urinated on herself. Six days later she was dead.
According to the medical examiner, her death was due to “complications
of chronic substance abuse with withdrawal.”

A subsequent
wrongful death suit alleged that Corizon and LMC employees were
negligent in failing to provide treatment for Sparks’ opiate addiction
and withdrawal. Corizon settled the suit under confidential terms. See:
May v. Corizon, Jefferson County Circuit Court (KY), Case No.
13-CI-001848.

Four months after Sparks’ death, on August 8,
2012, another LMC prisoner, Samantha George, died. A lawsuit filed in
Jefferson County Circuit Court claimed that George was moved from the
Bullitt County Jail to the LMC facility on a charge of buying a stolen
computer. According to the complaint, she told a Corizon nurse that she
was a severe diabetic, needed insulin, and was feverish and in pain from
a MRSA infection.

The nurse notified an on-call Corizon
physician, who was not located at the facility and thus could not
examine George in person, to decide if she should be taken to an
emergency room. The doctor recommended monitoring George and indicated
he would see her the next day. George’s condition rapidly deteriorated
while she was monitored by staff at the jail; she was found unresponsive
a few hours after being admitted to the facility and pronounced dead a
short time later.

An autopsy concluded that George died due
to complications from a severe form of diabetes compounded by heart
disease. According to the lawsuit, the Corizon doctor never saw George;
among other defendants, the suit named Corizon and LMC director Mark
Bolton as defendants. The case was removed to federal court, then
remanded to the county circuit court in October 2013. See: George v.
Corizon, U.S.D.C. (W.D. Ky.), Case No. 3:13-cv-00822-JHM-JDM.

A
few weeks after George’s death, Kenneth Cross was booked into the LMC
jail on a warrant for drug possession. According to a subsequent
lawsuit, upon Cross’ arrival at the jail a nurse documented that he had
slurred speech and fell asleep numerous times during the medical
interview. Several hours later he was found unconscious, then died
shortly thereafter due to a drug overdose. The lawsuit filed by Cross’
estate alleged that employees at the LMC jail were deficient in
recognizing and treating prisoners’ substance abuse problems and that
the facility was inadequately staffed for such medical care.

After
the deaths of Sparks, George, Cross and four other prisoners in 2012,
LMC director Bolton said he believed Corizon took too long to evaluate
and treat prisoners at the jail. According to the Courier-Journal,
Bolton sent an email to his staff in December 2012 regarding the
prisoners’ deaths, stating, “Mistakes were made by Corizon personnel and
their corporation has acknowledged such missteps.” He further indicated
that Corizon employees – not LMC staff members – were responsible for
the care of the prisoners who died. Six Corizon employees at the LMC
jail resigned in December 2012 during an internal investigation; they
were not identified.

Bolton’s criticism was too little, too
late to prevent the deaths of the seven LMC prisoners, though the jail
has since made improvements to its medical services, including a
full-time detox nurse and new protocols for prisoners experiencing
withdrawal. One could speculate that LMC’s critique of Corizon might be a
litigation tactic, to deflect responsibility. The fact remains that
seven deaths occurred under Corizon’s watch and, notwithstanding those
deaths, LMC was willing to renew its contract with the company.

In
January 2014, the Louisville Metro Police’s Public Integrity Unit
concluded investigations into three of the deaths at the jail, and
criticized both Corizon and LMC. The Commonwealth Attorney’s Office
found that Sparks’ and George’s deaths were preventable; however, no
criminal charges were filed. Dr. William Smock, a forensic examiner who
served as a consultant during the investigations, stated with respect to
George’s death: “There is compelling evidence of a significant
deviation from the standard of care and medical negligence on the part
of the medical providers.”

“I’m glad to see that the
government’s investigation matches exactly what our investigation
showed, which is that her death and others like hers is easily
preventable,” said Chad McCoy, the attorney representing George’s
estate.

Minnesota DOC

After providing medical care
to Minnesota state prisoners for 15 years, Corizon was not selected
when the contract was rebid in 2013 – despite having submitted the
lowest bid. Instead, competitor Centurion Managed Care was to begin
providing healthcare services in Minnesota’s prison system effective
January 1, 2014 under a two-year, $67.5 million contract.

Corrections
Commissioner Tom Roy said the contract with Centurion was expected to
“deliver significant savings to taxpayers while improving the quality of
care for offenders.”

According to the Star-Tribune, nine
prisoners died and another 21 suffered serious or critical injuries in
Minnesota correctional facilities due to delay or denial of medical care
under the state’s previous contract, which had been held by Corizon or
its predecessor, CMS, since 1998.

That contract was for a
fixed annual flat fee of $28 million. A flat fee contract provides an
incentive for the contractor to tightly control costs, as a reduction in
expenses results in an increase in profit. The Star-Tribune found that
many of the staffing arrangements negotiated in the contract played a
role in the deaths and injuries. For example, the contract allowed
Corizon physicians to leave at 4:00pm daily and did not require them to
work weekends. During off-hours there was only one doctor on call to
serve the state’s entire prison system, and many of the off-hour
consultations were done telephonically without the benefit of the
prisoner’s medical chart. Under the contract, Corizon was not required
to staff most facilities overnight.

The Minnesota Department
of Corrections was held liable for nearly $1.8 million in wrongful death
and medical negligence cases during the period when the state
contracted with Corizon or CMS.

In October 2012, a jury in
Washington County awarded Minnesota prisoner Stanley Riley more than $1
million after finding a Corizon contract physician, Stephen J. Craane,
was negligent in providing medical treatment. The Star-Tribune reported
that Riley suffered from what turned out to be cancer and had written a
series of pleading notes to prison officials. One read, “I assure you
that I am not a malingerer. I only want to be healthy again.”

In
May 2013, the state paid $400,000 to settle a lawsuit over the death of
a 27-year-old prisoner at MCF-Rush City. Xavius Scullark-Johnson, a
schizophrenic, suffered at least seven seizures in his cell on June 28,
2010. Nurses and guards didn’t provide him with medical care for nearly
eight hours. According to documents obtained by the Star-Tribune,
Scullark-Johnson was found “soaked in urine on the floor of his cell”
and was “coiled in a fetal position and in an altered state of
consciousness that suggested he had suffered a seizure.” An ambulance
was called several hours later but a nurse at the prison turned it away,
apparently due to protocols to cut costs. Corizon settled the lawsuit
for an undisclosed sum in June 2013. See: Scullark v. Garin, U.S.D.C.
(D. Minn.), Case No. 0:12-cv-01505-RHK-FLN.

Philadelphia, Pennsylvania

In
Philadelphia, Mayor Michael A. Nutter has been accused of being too
loyal to his campaign contributors, including Corizon. The company
donated $1,000 to Nutter’s 2012 campaign committee several months before
the city renewed Corizon’s contract to provide medical care to 9,000
prisoners in Philadelphia’s prison system. Further, PHS donated $5,000
to Nutter’s mayoral campaign in 2008.

The contract renewal
would have been routine except for the fact that Corizon’s performance
in Philadelphia has been far from stellar. In July 2012 the company
agreed to pay the city $1.85 million following an investigation that
found Corizon was using a minority-owned subcontractor that did no work,
which was a sham to meet the city’s requirements for contracting with
minority-owned businesses.

The renewed year-to-year Corizon
contract, worth $42 million, began in March 2013. Nutter’s
administration was accused of using the year-to-year arrangement to
avoid having the contract scrutinized by the city council; the city’s
Home Rule Charter requires all contracts of more than one year to be
reviewed by the council. Further infuriating opponents of the contract,
Corizon was not the lowest bidder. Correctional Medical Care (CMC), a
competitor, submitted a bid that would have cost the city $3.5 million
less per year than Corizon. Philadelphia Prison Commissioner Louis
Giorla defended the city’s decision to award the contract to Corizon at a
council hearing; however, he declined to answer questions as to why the
administration considered Corizon’s level of care to be superior to
that provided by CMC.

Three union contracts with Corizon
covering 270 of the company’s workers in Philadelphia’s prison system
expired on November 26, 2013. Corizon demanded benefit cuts, including
changes in employee healthcare programs, to offset wage increases
promised under the company’s contract with the city. A strike was
averted in December 2013 when the mayor’s office intervened and both
sides reached a settlement. The Philadelphia Daily News reported that
the new union contracts provide wage increases but also include a
less-generous health insurance plan for Corizon employees.

Since
1995, Corizon and its predecessor, PHS, have received $196 million in
city contracts. The company’s contract was terminated for several months
in 2002 as a result of complaints that a diabetic prisoner had died
after failing to receive insulin. The city renewed the contract anyway,
citing affordability and pledging increased oversight. The city’s law
department estimates that Philadelphia has paid over $1 million to
settle lawsuits involving claims of deficient prison healthcare; the
largest settlement to date is $300,000, paid to a prisoner who did not
receive eye surgery and is now partially blind.

Based upon
the number of lawsuits filed against Corizon alleging inadequate medical
care, its use of a sham subcontractor and the company’s treatment of
its own employees, it appears that maintaining the status quo – not best
practices – may be the controlling factor in Philadelphia’s continued
relationship with Corizon.

Allegheny County, Pennsylvania

On
September 30, 2013, a prisoner jumped from the top tier of a pod at the
Allegheny County Jail. Following an investigation, authorities refused
to make public their findings and declined to disclose the prisoner’s
injuries, citing medical privacy laws. The prisoner, Milan Karan, 38,
was not transported to the hospital until the following day.

A
spokesperson for Corizon, which provides medical care at the 2,500-bed
jail, defended the nearly 24-hour delay by noting the prisoner “was
under observation” before being sent to a hospital.

In
December 2013, the Pittsburgh Post-Gazette reported that Corizon was
having difficulty staffing the Allegheny County Jail. When the newspaper
requested a comment from Corizon vice president Lee Harrington,
Harrington claimed he had no knowledge of staffing problems – despite
having previously received emails from the facility’s warden about that
exact issue.

The staffing problems resulted in prisoners not
receiving their medication in a timely manner. In emails obtained by the
Post-Gazette, Warden Orlando Harper wrote to Harrington in October
2013, noting, “We are continuing to experience issues pertaining to the
following: 1. Staffing, 2. Medication distribution.” Also, on November
17, 2013, Deputy Warden Monica Long sent an email to Corizon and jail
staff. “I was just informed by the Captain on shift, the majority of the
jail has not received medication AT ALL,” she stated, adding, “Staffing
is at a crisis.”

That crisis had been ongoing since Corizon
assumed the medical services contract at the facility on September 1,
2013. Before the $62.55 million, five-year contract was awarded, Corizon
vice president Mary Silva wrote in an email that it was imperative the
jail have “adequate staffing on ALL shifts.” That promise was made
despite Corizon laying off many of the former employees of Allegheny
Correctional Health Services, the jail’s previous healthcare provider.

Allegheny
Correctional had provided four full-time and one part-time physician
during its contract tenure. Corizon reduced the number of doctors to one
full-time and one part-time physician. Allegheny Correctional also
employed three psychiatrists and one psychologist. Corizon’s contract
requires that it provide one full-time psychiatrist and a part-time
psychologist.

In January 2014, the United Steelworkers union
(USW) filed a petition with the National Labor Relations Board to
unionize Corizon employees at the Allegheny County Jail, including nurse
practitioners, RNs, physician assistants and psychiatric nurses. USW
representative Randa Ruge indicated that the Corizon workers had
approached the union for representation due to intolerable working
conditions.

“Our folks [Corizon employees] are in danger of
losing their licenses to practice by some of the things that the company
has them doing,” she said. Ruge told the Post-Gazette that the jail had
run out of insulin for more than a week and Corizon supervisors had
“countermanded doctors’ orders.”

Several weeks after the USW
filed the labor petition, a Catholic nun who worked as an RN at the jail
was fired by Corizon, allegedly for union organizing activities. Sister
Barbara Finch was dismissed after she openly expressed concerns about
staffing, patient care and safety at the facility. The USW filed an
unfair labor complaint against Corizon regarding Finch’s dismissal,
claiming she was terminated in retaliation for her union activities.

“This
is a clear case of intimidation and union-busting at its worst,” said
USW President Leo W. Gerard. “Sister Barbara has been an outspoken
advocate of change for these courageous workers and their patients, and
this kind of illegal and unjust action, unfortunately, is par for the
course with Corizon.”

On February 14, 2014, Corizon employees
at the Allegheny County Jail voted overwhelmingly to unionize. “The
next step is getting to the bargaining table and getting Corizon to
bargain in good faith and get some changes made in the health system at
the jail,” said Ruge.

The previous week, Allegheny County
Controller Chelsa Wagner stated she had “grave and serious concerns”
about medical care at the facility, including issues related to staffing
and treatment for prisoners with certain mental health conditions. “I
regard the current situation as intolerable and outrageous, and I fully
expect necessary changes to be urgently implemented,” she wrote in a
letter to Corizon.

Polk County, Iowa

On August 29,
2013, Ieasha Lenise Meyers, incarcerated at the jail in Polk County,
Iowa on a probation violation, gave birth on a mattress on the floor of
her cell. Her cellmates assisted with the delivery. Earlier, when
Meyers, 25, had complained of contractions, a Corizon nurse called an
offsite medical supervisor and was told to monitor the contractions and
check for water breaking.

Despite Meyers having been twice
sent to a hospital earlier the same day, and pleading that she was about
to give birth, the nurse did rounds in other parts of the jail. Guards
reportedly did not check on Meyers as required, even though the birth
could be seen on a nearby security monitor. Only after the baby was born
was medical care provided. Sheriff Bill McCarthy defended the actions
of jail staff.

Corizon Employee Misconduct

Like
most private contractors that provide prison-related services, Corizon
tends to cut costs in terms of staffing and operational expenses. As
noted above, this includes paying lower wages, providing fewer or
inferior benefits and hiring less qualified workers who can be paid
less. Sometimes, however, these practices result in employees more like
to engage in misconduct.

At the Pendleton Correctional
Facility in Indiana, a Corizon nurse was arrested and charged with
sexual misconduct, a Class C felony. The Herald Bulletin reported that
in April 2013, when Colette Ficklin was working as a contract nurse for
Corizon, she convinced a prisoner to fake chest pains so they could be
alone in an exam room. A guard told internal affairs officers that she
witnessed Ficklin and the prisoner engaging in sex acts in the prison’s
infirmary. [See: PLN, Sept. 2013, p.17].

In March 2013 at the
Indiana State Prison in Michigan City, a Corizon practical nurse was
charged with drug trafficking and possession with intent to distribute.
Phyllis Ungerank, 41, was arrested and booked into the LaPort County
Jail after attempting to smuggle marijuana into the facility. [See: PLN,
July 2012, p.50].

A Corizon nurse at the Volusia County
Branch Jail in Daytona Beach, Florida was fired after officials learned
she was having sex with and giving money to a prisoner. Valerie
Konieczny was terminated on December 18, 2012 when the jail was
contacted by the brother of prisoner Randy Joe Schimp, who had written
in a letter that a nurse was having sex with him and depositing money
into his jail account. Investigators determined that Konieczny was the
nurse who had sex with Schimp at both the Volusia County facility and
another branch jail in 2011.

In New Mexico, Corizon physician
Mark Walden was accused of fondling prisoners’ genitals and performing
prostrate exams that were “excessive and inappropriate in terms of
length and method.” At times, Walden reportedly did not wear gloves
during the prostate exams. He was accused of sexually abusing 25 or more
male prisoners while employed as a doctor at two privately-operated
facilities, the Guadalupe County Correctional Facility in Santa Rosa and
Northeast New Mexico Detention Facility in Clayton.

Lawsuits
were filed against Walden, Corizon and private prison operator GEO
Group, and Walden’s medical license was suspended in December 2013. The
suits claim that Corizon allowed Dr. Walden to work at the Clayton
prison “despite knowing of the risk of sexual abuse and having the
ability to know that [he] was repeatedly sexually abusing patients” at
the Santa Rosa facility. [See: PLN, Sept. 2013, p.47].

The Privatization Model

Economics
professors Kelly Bedard and H.E Frech III at the University of
California at Santa Barbara examined the privatization of correctional
medical services in their research study, “Prison Health Care: Is
Contracting Out Healthy?,” published in Health Economics in November
2009.

They concluded: “We find no evidence to support the
positive rhetoric regarding the impact of prison health care contracting
out on inmate health, at least as measured by mortality. Our findings
of higher inmate mortality rates under contracting out are more
consistent with recent editorials raising concerns about this method of
delivering health care to inmates.”

Today, five years after
the Bedard-Frech report was published, it has the benefit of hindsight.
Since the report was written, its findings and conclusions have been
reaffirmed in prisons and jails across the nation that have contracted
with private companies to provide medical care to prisoners. Cost
reductions in the provision of correctional healthcare tend to result in
greater inefficiencies that lead to poorer outcomes. Consequently,
for-profit medical contractors may actually be increasing morbidity and
mortality in prison and jail populations.

Many governmental
entities are willing to outsource correctional healthcare to private
companies; reasons for doing so include cutting costs, risk management
and removing healthcare duties from corrections departments. If
Corizon’s record with respect to providing medical care to prisoners
seems dismal, the company can always defend its actions by stating it
does what it has been hired to do: Cut costs for its customers. And
those costs have been rising due to an increasingly aging, and thus
medically-needy, prison population. [See: PLN, Nov. 2012, p.22; Dec.
2010, p.1].

With respect to risk management, litigation is
not a compelling issue within the prison healthcare industry and Corizon
views lawsuits as simply a cost of doing business. “We get sued a lot,
but 95% or 97% of cases were self-represented cases,” ex-CEO Rich
Hallworth was quoted in an August 2013 article. He added that most
lawsuits settle for an average of less than $50. Of course it is
difficult for prisoners to obtain representation to pursue litigation –
unless it’s a wrongful death case, and then usually their family or
estate is doing the suing.

Nor are the public agencies that
contract with private medical providers greatly concerned about their
litigation records. In fact, when Florida contracted with Corizon and
Wexford Health Sources to provide medical care for the state’s entire
prison system, the Florida Department of Corrections didn’t ask the
companies about their litigation histories – such as lawsuits raising
claims of deliberate indifference, negligence and medical malpractice.

“What
really troubles me about this is the fact that the department didn’t
ask these very basic, elemental questions any system would ask,”
observed ACLU National Prison Project staff attorney Eric Balaban.
“These two vendors were taking over Florida’s massive health care system
and you’d think they would have asked hard questions to determine if
these companies can provide these services within constitutional
requirements.”

Even worse, the downgrading of Corizon’s debt
rating by Moody’s in 2013 creates a potential problem for the company’s
service delivery model. The majority of Corizon’s revenue is derived
from contracts with state and local agencies that are trying to reduce
their budgetary expenses. Given those fiscal pressures and competition
from Wexford, Armor, Centurion and other prison healthcare companies,
Corizon cannot easily increase its revenue through contractual price
increases. But the company’s expenses are largely within its control.

Unfortunately
for prisoners, in order to reduce costs Corizon will likely have to
curtail the quality or quantity of healthcare services it provides. As
noted above, this can be done by reducing employee wages or benefits;
the company can also cut costs through understaffing and by limiting
prescription medications or providing fewer referrals to hospitals and
specialists. A growing trend is to use off-site medical staff who
consult with prisoners through telemedicine. [See: PLN, Dec. 2013,
p.34].

The correctional healthcare industry, comprised of
only a few large companies, is highly competitive. When one company
loses a contract, another is more than willing to step in and submit a
bid. What really matters for most government agencies and policymakers
is the bottom line cost.

According to Dr. Marc Stern, the
court-appointed special master in Idaho, “whoever delivers prison
healthcare is doing it on less than adequate funding because that’s how
much municipalities, state legislatures and county commissions are
allocating.” He noted that privatization can be good in some cases and
bad in others, depending on the level of oversight by the contracting
public agency.

When Corizon compromises medical care to save
money, such as curtailing the use of ambulances for emergency
transports, reducing the number of on-site doctors or sending fewer
prisoners to outside hospitals for needed treatment, government
officials typically fail to take corrective action and deny
responsibility for the resultant deaths and injuries. Indeed, as with
the Idaho Department of Corrections and LMC in Kentucky, they sometimes
want to reward the company with renewed contracts.

Why? Because
continuity maintains cost control, which is the driving force behind
privatization of prison and jail medical services.

Conclusion

The
intent of this article was to review Corizon’s performance and
practices based on publicly-available information, including news
reports and court records. Although the company was formed in June 2011,
its two predecessor firms, PHS and CMS, littered the news and judicial
dockets over the years with lawsuits and articles involving cases of
inadequate healthcare. Thus, the sins of Corizon’s parents, CMS and PHS,
are forever linked with the progeny of their merger.

Such past
misdeeds could be explained away had Corizon adopted a new, post-merger
culture that was removed from prior practices under PHS and CMS.
However, many of Corizon’s mid-level and top executives – including
ex-CEO Rich Hallworth, former president Stuart Campbell, chairman
Richard H. Miles and a number of vice presidents – were previously
executives with PHS or CMS. It was during their tenure at those
companies that numerous cases involving deficient medical care occurred.

The
corporate culture of Corizon, as well as its business model, appears to
be largely the same as those of its predecessors. Therefore, the only
thing that may have changed as a result of the merger that created
Corizon is the company’s name.

Gregory Dober is a freelance
writer in healthcare and ethics. He has been a contributing writer for
PLN since 2007 and co-authored Against Their Will: The Secret History of
Medical Experimentation on Children in Cold War America, published by
Palgrave in 2013. [See: PLN, Nov. 2013, p.36].